Longitudinal Endosonography Atlas and Manual for Use in the Upper Gastrointestinal Tract. T. Rosch, U. Will, K.J. Chang (Editors)

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1 Longitudinal Endosonography Atlas and Manual for Use in the Upper Gastrointestinal Tract T. Rosch, U. Will, K.J. Chang (Editors)

2 Springer Berlin Heidelberg New York Barcelona HongKong London Milan Paris Singapore Tokyo

3 T. Rosch U. Will K.J. Chang (Editors) Longitudinal Endosonography Atlas and Manual for Use in the Upper Gastrointestinal Tract With 320 Figures Springer

4 Rosch, T. 2. Medizinische Klinik Klinikum Rechts der Isar der TU Munchen Ismaninger Strasse 22 D Munchen, Germany Tel.: ; Fax: ; Will, U. Klinik fur Innere Medizin I Friedrich -Schiller-Universitat Jena Erlanger Allee 101 D Jena, Germany Tel lO8; Fax.: WILL@polkim.med.uni-jena.de Chang,K.J. UCI Medical Center Chao Family Comprehensive Cancer Center Gastrointestinal Oncology lol, The City Drive, Bldg. 23, Rt. 81, Rm. 330 Orange, C92668, USA ( kchang@uci.edu) Springer-Verlag Berlin Heidelberg New York Die Deutsche Bibliothek - CIP-Einheitsaufnahme Longitudinal endosonography: atlas and manual for use in the upper gastrointestinal tract/tho Rosch... (ed.). - Berlin; Heidelberg; New York; Barcelona; Budapest; Hong Kong; London; Milan; Paris; Singapore; Tokyo: Springer, 2001 ISBN-13: DOl: / e-isbn-13: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts there of is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg New York a member of BertelsmannSpringer Science+ Business Media GmbH Springer-Verlag Berlin Heidelberg 2001 Softcover print of the hardcover 1 st edition 2001 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: design & production, Heidelberg SPIN: / Printed on acid-free paper

5 Endoscopic ultrasonography is now about 20 years old. It has significantly extended our diagnostic possibilities in gastroenterology. Due to its unique diagnostic capability that allows high resolution imaging of the GI wall and neighbouring organs, more information can be obtained about the local extent and growth of gastrointestinal and pancreatobiliary tumors. In addition, EUS has substantially contributed to the diagnosis of small pancreatic exocrine and endocrine tumors as well as submucosal gastrointestinal lesions. A large body of literature has accumulated, that shows good to excellent accuracy rates of EUS in these indications. These indications have been established by numerous papers and consensus statements of endoscopic societies. The more recent papers, concentrating on the influence of EUS on outcome and on cost effectiveness, have also shown a distinct role of this procedure in diagnostic gastroenterology. There are, however, also limitations of EUS. These mainly lie in the limited ability to differentiate between benign and malignant lesions. One way to solve these problems, at least partially, has been the introduction of EUS guided fine needle puncture. To perform this safely and effectively, longitudinal scanning echo-endoscopes were developed. Previously available radially scanning instruments are considered not as suitable for this purpose. Since most papers on diagnostic EUS have been published with respect to the radial scanner, there is little experience in the literature on the accuracy of linear scanning in the classical indications of EUS. The few comparative studies suggest, that both instruments may be equivalent regarding the standard applications of EUS. However, there is little basic information about linear anatomy whereas the number of publications on EUS guided fine needle puncture is still growing. The present book will hopefully serve as a tool to endosonographers, who are working exclusively with the longitudinal scanners. The anatomy section correlates the endosonographic images with cross-sectional anatomy. The whole spectrum of pathological findings is then presented in detail with some tips and tricks. Finally, EUS guided puncture and the recent field of EUS-related therapy are covered in detail. We are extremely grateful to our coauthors, who have invested enormous work into this project. The pictures were collected from a large pool during two conferences of the participating authors and reviewed by the group. Our special thanks go to Dr. Raman Muthusamy for his tremendous effort in clarifying the EUS terminology. Mr. Holger Frey from Hitachi Ultrasound did a tremendous job in putting the pictures into an electronic format. We would like to convey special thanks from the authors to him. The present book is supported by Hitachi Ultrasound, based on an initiative by Mr. Karl-Heinz Pelster, and the Pentax Company. It is for this reason that only images produced by Pentax/Hitachi are included. The same anatomic principles, however, also apply to other longitudinal instruments. With Springer-Verlag as our publisher, we are be confident that the widespread distribution of this book as an educational tool is guaranteed. We also thank Mr. Thomas Gunther, from Springer, for his oversight and organization. On behalf of the authors, we hope that this book will be of practical help to the users of linear echoendoscopes, showing the advantages and limitations of longitudinal EUS and being instructive for performing EUS guided fine needle puncture. Thomas Rosch Uwe Will Kenneth J. Chang

6 Part 1 Basic Principles Basic Principles and Technology W. Plies, M. Stief Papilla of Vater 13 Vessels Adrenal Glands Indications J. Janssen, L. Greiner 15 Miscellareous Findings Examination Technique and General Principles J. Janssen, L. Greiner Part 2 Normal Anatomy and Landmarks - Imaging Techniques U. Will, E. Burmester, J.- U. Erk 4 Esophagus and Mediastinum The Stomach and Paragastric Region 33 Part 4 Diagnostic Fine-Needle Biopsy P. Vilmann and G. K. Jacobsen 16 Indications EUS-FNA Technique Cytopathology Interpretation Study Results Limitations and Complications The Duodenum and Pancreatobiliary System Part 3 Pathology E. Burmester, J.-U. Erk, C. Jakobeit and L. Weip J. Janssen and L. Greiner, P. Kann, T. Rosch, H. Seifert, P. Vilmann and G. K. Jacobsen, U. Will, M. Wittenberg Part 5 Therapy 21 Interventional Therapeutic Endosonography: Current Status H. Seifert 22 Interventional Therapeutic Endosonography: Future Perspectives Y. K. Chen, K. J. Chang Esophagus Mediastinum Stomach Appendix References 171 Abbreviations Pancreas BiliaryTract Tumor Staging Classifications 177 Subject Index 179

7 Burmester. E. Stadtisches Krankenhaus Sud Zentrum Innere Medizin Kronsforder Allee D Lubeck, Germany Tel.: ; Fax: Chang,K.J. UCI Medical Center Chao Family Comprehensive Cancer Center Gastrointestinal Oncology 101, The City Drive, Bldg. 23, Rt. 81, Rm. 330 Orange, C92668, USA Chen,Y.K. Division of Gastroenterology & Hepatology University of Colorado Health Sciences Center Campus Box B East Ninth Avenue Denver, CO Tel (303) ; Fax (303) ; efax (781) Erk,J.-D. Abt. Innere Medizin, Diakonissenkrankenhaus Holzhofgasse 29 D Dresden, Germany Tel.: ; Fax: Greiner, L. Klinikum Wuppertal, Medizinische Klinik 2 Abt. Gastroenterologie und Hepatologie Heusnerstrasse 40 D Wuppertal, Germany Tel.: ; Fax: Jacobsen, G.-K. Copenhagen University Hospital Gentofte Dept. of Pathology DK-2900 Hellerup, Danmark Tel.: ; Fax: Jakobeit, C. Johanniter-Krankenhaus, Innere Medizin Siepenstrasse 33 D Radevormwald, Germany Tel.: ; Fax: Janssen,J. Klinikum Wuppertal, Medizinische Klinik 2 Abt. Gastroenterologie und Hepatologie Heusnerstrasse 40 D Wuppertal, Germany Tel.: ; Fax: ; jjanssen@klinikum-wuppertal.de Kann,P. Klinik und Poliklinik Innere Medizin Schwerpunkt Endokrinologie und Stoffwechselkrankheiten Klinikum der Johannes-Gutenberg Universitat Mainz D Mainz, Germany Tel.: ; Fax: ; pkann@mail.uni-mainz.de Muthusamy, v'r. Division of Gastroenterology University of California San Francisco Box 0535, S Parnassus Avenue San Francisco, CA USA

8 x Contributors Plies, W. Product -Manager Hitachi Ultrasound GmbH Kreuzberger Ring 21 D Wiesbaden, Germany Tel.: ; Fax: ; Rosch, T. 2. Medizinische Klinik Klinikum Rechts der Isar der TU Munchen Ismaninger Strasse 22 D Munchen, Germany Tel.: ; Fax: ; Seifert, H. Medizinische Klinik II, Endoskopie, Abteilung fur Gastroenterologie Johann-Wolfgang-Goethe-Universitat Theodor-Stern-Kai 7 D Frankfurt / Main, Germany Tel.: , Fax: seifert@em.uni-frankfurt.de Stief,M. European Sales/Marketing Manager Pentax GmbH Julius-Vosseler-Strasse lo4 D Hamburg, Germany Tel.: ; Fax: medica@pentax.de Vilmann,P. Copenhagen University Hospital, Gentofte Dept. of Surgical Gastrointesterology DK-2900 Hellerup, Danmark Tel.: ; Fax: pevi@gentehoftehosp.khamt.dk Welp,L. Johanniter-Krankenhaus, Innere Medizin Siepenstrasse 33 D Radevormwald, Germany Tel.: , Fax: Will, U. Klinik fur Innere Medizin I Friedrich-Schiller-Universitat Jena Erlanger Allee 101 D Jena, Germany Tel.: lO8; Fax: WILL@polkim.med.uni-jena.de Wittenberg, M. Prosper-Hospital Akademisches Lehrkrankenhaus der Ruhr-Universitat Bochum Medizinische Klinik Muhlenstrasse 27 D Recklinghausen, Germany Tel.: , Fax: markus.wittenberg@ruhr-uni-bochum.de